Have I finally found my friends? (Palmer has crossed over the Bridge)

Leslie and the girls-
"The sex steroids are almost always (I’d say always) increased when a dog is on trilostane. "
Why is this a "bad" thing?

Also-one of my concerns is that the vet now thinks that Palmer is regular cushings'. Jack said that if Palmer was on Trilostane when they did the panel-he is. Well, he was not on the Trilostane then. I know we've had part of this discussion before.....can we again?:confused::confused::confused:

-Susan

Hi Susan,

Why is it a bad thing if the other hormones are elevated even tho the cortisol may be controlled? Because the other five hormones will cause the same damages in the body as the cortisol will if not controlled. They also cause the same signs as cortisol. The Trilo is more than likely NOT controlling those other hormones and is, in fact, causing them to be even higher than they would be in an untreated state (this is based on his continuing/worsening signs). The Trilo will lower cortiol, but it also elevates the other hormones that Palmer is over-producing naturally. For a pup with hormones OTHER THAN cortisol (like Palmer), Trilostane is a two-edged sword...helping one area (cortisol), while making another area worse (Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and/or Aldosterone).

In looking at Palmer's cortisol history, it is kinda puzzling to me. Has he had an ultrasound lately? If not, I highly recommend he have one soon. Based on the first ACTH through UTK, he does not have true Cushing's, but that post number has jumped all over even after treatment with the Trilo. So if it were me, I would want to be sure there isn't some other cause for his cortisol to be elevated - and fluctuating. You may remember that Squirt was diagnosed as PHD (true Cushing's) but since that splenic tumor was removed, her cortisol has returned to normal levels. Dr O was saying that if he was already on the Trilo when that test was done, then it would have lowered the cortisol giving a much lower reading than it would have if not treated - therefore leading to a diagnosis of conventional/true Cushing's. Since he was NOT on Trilo at that time, his cortisol levels do not support that diagnosis at that time. That could have changed over time, tho.

If it were me and my pup, I would stop the Trilo immediately - today; schedule an ultrasound asap; set up the UTK test for a month from now assuming the U/S is good. I am not sure of the life of melatonin and lignans in the body, but I would also stop them within a week to be sure the UTK panel reflects his true, untreated state. Then, assuming the UTK results still support the Atypical diagnosis even if the cortisol is elevated, tell my vet we would be switching to Lyso. IMHO, the experiment with Trilo has failed miserably for him and he continues to suffer as indicated by his continuing signs which means damage continues to progress.

I hope this helps.
Hugs,
Leslie and the girls

Medical complications from untreated Cushing's:
http://www.k9cushings.com/forum/showthread.php?t=195

Susan, I don't have much to add to what Leslie has already told you. The other hormones are still considered to be various types of steroids. Excess steroid, whether it is cortisol or one of the intermediates, does damage to the internal organs over the long term. This is why with a diagnosis of Atypical it's extremely important to get those intermediates under control. Lysodren will do that for you. The "catch 22" here is going to be estradiol as estradiol is also produced in non-adrenal tissue, such as adipose & I believe brain tissue, also. This is why the lignans + melatonin is used to control the non-adrenal production of estradiol. All adrenal produced hormones will be controlled by lysodren. I would almost bet that you will not have to put Palmer through a typical lysodren loading phase, & will simply need to add a maintenance dose of lysodren to his melatonin + lignans. If you & your vet want to see just how serious the effects of trilostane are on the intermediate hormones, you can have that UTK panel done right now. If you need to see what the levels are in an untreated state, Palmer will have to have a "washout" period of 30 days before the UTK panel can be done.

Debbie

Hi folks-

Now, let's all take a deep breath...............:(
First, Palmer's blood pressure is just fine.:D

Now-this is where we stand. We have agreed to give Palmer Trilostane, one capsule in the AM (30mg) and 1/2 capsule in the PM. We tried that before and Palmer had an immediate reaction. If the same occurs, we will immediately stop the Trilostane and that will be the end of it.

Regardless of how that turns out, we now have an appt. with an Endocrinologist. Sadly, not until 9/1. I'm not sure if he'll choose to run any tests or not, but Palmer will be fasting before we go. I know with Trilostane in his system it may skew the results.

If the Endocrinologist agrees with the Trilo. treatment.....I don't know what. (Well-yes, I do. The vet will not support us if we go against the two of them.) If he agrees with the Lysodren, after a wash out period we will start that. The vet will support that. So I guess the bottom line is this dude gets to determine whether or not we're going to need to change vets. (Anybody still with me?)

(I really hate having to write this to you guys. I got boxed in a bit here. There are no good viable options for a different Vet nearby.)

Jennifer states she does not have a problem with Lyso. She feels we had such good results when we first started the Trilo and that to switch now ("that we may be so close to having this solved") is just not the right thing to do. She also said she feels she is being pressured into doing something that goes against what she believes is the best treatment, at this time. She said that if the Lyso did not work, we'd be right back trying to find an answer with the Trilo. I reminded her that she offered Lyso as an option in the beginning. She remembers that....but it gets back to giving the Trilo a good chance.

The endocrinologist is at the place where we went for the UTK sample to be drawn the first time, so if we want to do that, we'll be all ready to go ahead with it. She is sending us to a different doc from the one we went to originally. I think the first go round we got the luck-of-the-draw amongst the Internists.

I gave her a modified transcript of the emails from Dr. O. (I removed any references to her.) His words were highlighted. She says she wants to and will read that. I think she was quite surprised to learn I had been conversing with Dr. O.

She made reference to my research. She said she admired all I had done. BUT-she could tell from my questions that I did not understand it completely. :mad::mad:She said some of my questions just did not make sense. :confused: :confused: (I do think this was a defensive reaction.)

My husband has not taken part in all this stuff, so when she asked him what he thought his response was that he did not want to run a lot of unnecessary tests. She had said the UC:CR was one example of a test she felt was unnecessary. She said it would not really tell us much at this point. She said it was a tool to determine if the pet had Cushings' at the start.

I don't see the harm in getting a second opinion. I know it will cost more time if we wind up going to the Lyso. I feel it would be much more costly, dollar and time wise, if we had to switch vets now.

I wish I had different news, but that's where we stand for now. I will take all of the volumes of documentation I have to the Endo. I will especially point out Dr. O's responses.

Please don't think I don't have the backbone to fire the vet or that I lack wanting the best of care for Palmer....for dollars or for any other reason. Perhaps this will resolve itself in the next day or two if Palmer has the same reaction to the increased Trilo. If we end up sending a sample to UTK, I will alert Dr. O that it is coming.

I hope you all will stick with me as we try to figure this out. I DID NOT ignore your many suggestions. As I said before-I really appreciate all you have to say and all the time you have taken.

-Susan

Hi Susan,

Of course we will stick with you! I am very concerned about Palmer, tho, and will continue to advocate stopping the Trilo. It really blows my mind that your vet will not take the word of a world renown doctor concerning the effect of Trilo on the other hormones involved in Atypical Cushing's. With Palmer's continuing signs I fail to understand what more she is looking for as an indication it is not doing the job. It is my fervent prayer that Palmer does not suffer as a result...well not much longer anyway before she listens to those who know more than she - meaning Dr. Jack Oliver.

I am sorry you are being torn like this and hope you understand that our goal is what is best for Palmer. Hopefully there are many things we don't understand in his whole picture.

Hang in there!
Hugs,
Leslie and the girls

Leslie and the girls-
Thanks so much. I'm glad you understand.

I was just thinking about the topic of replacing my vet. Another consideration I have is that if something of an urgent nature were to happen to Palmer, I'd have to go another 45 minutes to find the nearest qualified vet. It is best for Palmer to have that resource available. Hopefully this 3 weeks will not be harmful to him.

He had his extra 1/2 capsule tonight. No reaction so far.....but it did not happen until the following day the time we attempted to increase his dosage before.

-Hangin' in here.....................

Hi Susan,

I'm sorry you're going thru such a rough time with Palmer and your vet...I wish she would of let you run another UTK panel tho. :o

But what is done...is done...I also wish there was a cushing-computer out there...all you have to do is type in all of your pups numbers and poof it tells you what to do.

We know you love Palmer very much and no one doubts that, we just don't understand the logic of vets sometimes.

I'm hangin here with ya. :)

Love and hugs.
Lori

Susan,

We are here to share our experiences and research. It is our goal as a group to help people not place burden on them.

You do not need to justify your descisions to any of us, all any of us here really owe another is common courtesy.

There will be people here who no doubt may disagree with Palmer's treatment based on what you have related to us. No one does it to berate you or your Drs.

I continue to wish you the best in your treatment of Palmer and hope the new Dr. brings clarity to his treatment.

Scott

Thank you Lori and Scott.
It is possible we will run another UTK test when we go on 9/1. I just plan to take all the information I have; all the test results and see what happens. I also plan to present my case, if necessary.

-Susan

Question-I spoke today with a woman who use to groom dogs. She asked if I could still pick Palmer up. I thought she was referring to weight. She told me Cush dogs get to a point where it hurts them to be picked up. Any idea if that's one of the symptoms? I've never read nor heard of that before. Palmer did yelp when I picked him up over the weekend.....and I had/have no idea why. I picked him up very carefully as I always do.

Thanks.

s